A quick video of some of the ways that I use the GoTalk Now Plus AAC app from Attainment Company, Inc. It has several unique features that make it a “must have” on any speechie’s iPad 😃.
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In case you are wondering how the sound is that loud… This is my 9.7″ iPad Pro. It is in an original Gripcase USA case with handles on all four sides. I made a “bumper” out of a piece of pool noodle to prevent the bottom handle from getting bent out of shape when using my iPad on my lap.

Pursuing funding for augmentative communication devices is not for the timid or the faint of heart.

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Unless you are working with a family who is very wealthy and can afford to purchase it themselves you need to be prepared for the paperwork & “fiery hoops”.

The funding department at the company selling the device will provide valuable support but a lot will rest on the shoulders of the SLP submitting the funding request.

It is wise to get as much information as you can before you start the process. Read through the definition of “medical necessity” and all the required elements for purchase of a speech generating device (SGD) as durable medical equipment (DME) for that insurance company and/or Medicaid in your state. This will give you both verbiage to include in your report and a checklist of all the bases you need to cover.

In my most recent funding request I had to deal with both the requirements of private insurance and Medicaid. Each had their own requirements. This patient’s insurance company required at least a 30 day trial with the SGD being requested. Medicaid in my state requires a video demonstrating clear communicative intent, independent use and for eye gaze devices “proof of accuracy”. Trying to submit a funding request before we had all of those elements would have been fruitless.

“Proving accuracy” may not sound like a big deal but I can testify that it was a huge fiery hoop when the patient was a 2.5 year old who had huge meltdowns every time I tried “show me the _____” activities. As in several sessions went down the toilet because we tried that.

So I laid in bed at night mulling over the quandary of how to “prove accuracy” in order to get her the AAC device that I knew she needed and that she had already shown me she could use. Add the extra self induced pressure of desperately wanting to get this accomplished before my retirement. Thank the Lord for stumbling upon a toy that this child was intrigued by. Not really the most highly preferred item. In fact early in the trial of the eye gaze device her Mom and I thought she may have been accidentally activating the button to request it since her reaction upon getting the toy was pretty “meh” 😐. So her Mom asked if I could move the button for it to a different location. Guess who immediately activated the button for that toy again and gave us her famous impish grin. Every time I moved that button she found it and grinned. So that was our golden ticket to making it through the fiery hoop of “proving accuracy”. I added a tiny button to her home page in Communicator 5 on the Tobii Dynavox i15+ eye gaze SGD and linked it to a page set that I built with the “noisy ball” and three other items with the placement randomized on each page. The first session I showed it to her she was a little fussy so we didn’t stay there long. The next week she was well rested and especially perky. Guess who found the “noisy ball” with 100% accuracy when presented in a playful way as a game of “hide and seek”? Yup. She did. And I got it all on video including her huge smile at the end as if to say “I rocked that didn’t I?”.

Tip: When you are required to provide a video with your funding request it’s important to always have a means of videoing on you in all sessions so you can capture the moments.

That was a huge fiery hoop to make it through and I worked late that evening to start the AAC eval report to get the funding request process started. Here’s the deal…. once you start that ball rolling you have to be willing to do what it takes under very short timeframes when they request additional video or ask for an addendum for additional information. If you don’t meet their very short timeframes then the request will automatically be denied and you have to start all over. For this child I had to provide documentation as to why she could not use handwriting as a means of communicating (ummmm…… not a developmentally appropriate expectation for any 3 year old let alone one with Rett Sydrome and no functional hand use) & additional videos proving she was making independent and intentional requests with the SGD. All of which had already been documented both in video and in writing. Of course I was frustrated every time but I had to vent to my fellow SLPeeps and then did what it took to make it through that next fiery hoop. I cried tears of relief and joy when I finally got the e-mail that her SGD had been approved and the day it arrived.

In the end it is all worth it to see the look on a child’s face when they get to take home their “voice” for the first time.

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I’m not sharing this to brag on myself but rather to leave pearls of wisdom learned from my 28 year career as a SLP. I’ll be retiring in 11 weeks so I’m trying to pass along things that I’ve learned before I move on to the next chapter in my life. I spent several hours researching the internet and posting in AAC and SLP Facebook groups begging for ideas for how to “prove accuracy” for a 2.5 years old using an eye gaze device. But there was nothing. So I hope that this info helps some other speechie in the future. For your patient it will likely be some other random toy or activity but the concept of turning it into a playful “hide and seek” activity may be your ticket to making it through the “proving accuracy” fiery hoop.

Have you ever had a patient who you knew had something to say but you struggled to find a means of communication?

I spent almost a year trying literally EVERY possible AAC device and app and every type of access option in a quest to find a “voice” for a child who I knew had so much to say. She made it very clear that she wanted to use her hands for direct access despite having minimal use of them. She hated head pointing and eye gaze devices and any type of scanning. I would seriously lay in bed at night and ponder what else we could try. I spent hours scouring the internet looking for PODD resources and watched just about every video I could find. Thank goodness a PODD training finally came close enough and was priced affordably enough that our facility sent two SLPs to get trained. Ideally I would have gone to that PODD training but it didn’t make sense for me to take a spot being so close to retirement. But having two of our SLPs trained gave me access to a PODD book to trial with her and then was able to order a premade one for her. Ideally you would custom make and print a book but the facility where I work had not figured out the logistics of printing on special water and rip resistant paper and spiral binding. So I have customized the premade PODD book for her by using clear packing tape to add symbols. Her older sister has even hand drawn a few symbols and the family has written lists on the back of pages. It may not be perfect but it’s working for her. She is my PODD rock star. Every week I end my session by telling her to “PODD on” (rock on with PODD).

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I’m sharing links to things that were helpful during this PODD adventure and a few lessons learned….
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What does PODD stand for? Pragmatic Organization Dynamic Display
.How to get started? Ideally go to a PODD training….. but the reality is they may not be offered anywhere near you and they tend to be very expensive. This was my reality so I learned as much as I could online through blog posts, workshop handouts, videos, Facebook groups, etc….

One of the biggest mind shifts for me was to let go of the need to plan contrived communication opportunities in therapy sessions and instead model initiating saying “I have something to say” through facial expression, raising my hand and vocalizing and then using PODD to share my own thoughts or ideas. I had to get comfortable with doing lots of modeling without any pressure on the child to do anything. And comfortable with writing measurable goals in a whole different way.

Examples of some of the goals that I have written for her during this process:

“__________ will show increasing interest and attention to someone using pages from the PODD aided communication system to talk to her in natural contexts throughout the day. This will be measured by an increase in: looking towards the communication symbols or the communication partner, calming during this process, looking away to the side but with a stillness as if listening, or responding the partner’s message. Will increase from ______ to at least _______ times documented during the auth period.”

“Within natural contexts throughout the day, _________ will initiate use of PODD AAC by raising her hand and/or vocalizing to indicate “I have something to say”. Will increase from _______ to at least ________ times documented during the auth period.”

“After signaling “I have something to say”, __________will express an increasing range of communicative functions such as requests, comments, and directing actions using direct selection and/or partner assisted scanning with pages from the PODD communication book and yes/no responses. Will increase from_______ to at least ________ times documented during the auth period.”
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Reading these 1 page PODD tip sheets helped break the concept into manageable chunks: http://interactivespeech.com.au/podd-communication-focus-handouts.php

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This weekend I found these handouts and videos on Linda Burkhart’s website about PODD:

Options for purchasing premade PODD books (you have to sign a confirmation that you own both the Boardmaker and PODD software). A big shout out to Rachael Langley & Kelly Fonner for helping me find the first two options! The third one was seen in a Facebook group:

So I’ve been frustrated that I’m always fumbling through this patient’s PODD book in sessions. I wish there was a “word finder” for PODD (one of the downsides of a no tech system). I’m pretty “at home” with most AAC devices and apps since I have had lots of time to look through them and use them. I wanted to have this same level of ease in using PODD so I decided that I needed a copy of the same style of PODD book that she is using.

Unfortunately I can’t use the Tobii Dynavox PODD pageset in the Compass app to model since it doesn’t look anything like my patient’s PODD book. Since I am only 14 weeks away from retirement it did not make sense to spend about $80 to order a premade PODD book for me. I had seen comments online of folks saving a PODD book as a PDF so that’s what I decided to do. I saved the PDF in iBooks on my iPad. Now I have a way to look through it to get a feel for what vocabulary is in it and the pragmatic branching.

Be forewarned ….. it’s a VERY tedious & time consuming process to save a PODD book into one PDF if you are using Boardmaker 6 on a CD. It took me about 3 hours for a 123 pages of PODD. It’s not hard but time consuming.

You have to repeat the process for every single page that you want to include in the PDF of your PODD book. (I don’t have access to Boardmaker Online so I don’t know what the steps are there).

After you have all your pages saved as PDFs, then go to the Small PDF website (https://smallpdf.com/merge-pdf). This website lets you upload an unlimited number of PDFs. I uploaded all 123 of the PDF documents that I wanted included in this PODD book. After they are all uploaded then you hit “merge”. I was surprised how quickly this website handled merging 123 separate PDFs into one 123 page PDF document. I then uploaded the merged PDF from my computer into the media storage on my blog (a secured area that only I have access to). From there I was able to e-mail the link to the iPad that I use for AAC and opened the PDF in iBooks to save it on the device.

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Gayle Porter has reportedly been working on an “alternative access” version of PODD for quite awhile but as of the time of this post it is still not available here in the USA. So I made these very simple eye gaze boards inspired by PODD to use with a couple of other older patients.

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I may add more PODD resources to this post in the future. Just so it’s clear…. I’m definitely not an expert on PODD. I’m just a speechie who was willing to jump out of my comfort zone to find a means of communication for this patient and thought it would be helpful to share resources that took countless hours to find. If you have questions about this form of AAC I suggest going to one of the Facebook groups listed above. It’s where all the PODD gurus are 😉

It’s amazing to see how much the field of AAC has changed over the course of my 28 year career as a SLP. Long gone are the old days of it taking years to see any major changes or improvements in AAC options. We are living in an era of rapid advancement thanks largely to social media that provides the opportunity for AAC users, therapists, teachers & parents to provide direct input to app and technology developers regarding what features we need. Most good AAC apps are now updated several times a year. Here is my list of top 10 updates that occurred for AAC apps in 2017:

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#1: Proloquo2Go – in March 2017 version 5.0 added an amazing Search feature & Progressive Language. If you haven’t checked out this AAC app in awhile, I invite you to take a look at it again. These new features are a game changer. It also now includes English, Spanish, French & Dutch languages.

#2: Speak For Yourself – in January 2017 version 2.6 made this a Universal iOS app that can be used on an iPhone, iPod Touch & iPad. It also includes room for up to 40 different users (a great feature for SLPs trialing AAC with several different patients). Other updates this year added options to share vocabulary via AirDrop, more buttons became editable, the sentence bar background color can be changed & a “Manual Whisper Mode” was added to allow users to create a whole sentence prior to speaking.

#3: LAMP Words for Life – in July 2017 version 1.6.0 added a bilingual Spanish/English pageset, Word Finder updated to show and take you through the path to a word and added the option to backup to DropBox.

#4: TouchChat with WordPower HD – several updates added new pageset options, Arabic language added through an in-app purchase, Canadian French vocabulary files available as free upgrade and vocabulary files can now be backed up to DropBox and can be shared via E-mail and iMessaging.

#5: GoTalk Now Plus – in March 2017 version 4.11.6 added PCS Thinline symbols as an option through in-app purchase. In September 2017 version 4.11.11 added the option for Hybrid Scene pages (visual scene + up to 4 buttons) & the option to share messages from the Express Bar to Facebook, e-mail and text messaging.

#6: Snap + Core First – this new app was just released in June 2017 and in December 2017 already had a major update to add a bilingual Spanish/English pageset option & Spanish voices. At the end of October 2017 they added access to voice output in the free version of this app for ASHA certified SLPs as part of your MyTobiiDynavox account.

#7: Avaz Pro – in May 2017 version 4.2.6 added the option of having up to 77 buttons per screen. In September 2017 version 4.3 added the option to share via AirDrop and the Search now takes you through the path to a word.

#10: Custom Boards Premium by Smarty Ears had a major overhaul. New templates and updated Smarty Symbols were added. A great affordable option for making printable choice boards and visual supports.

https://itunes.apple.com/us/app/custom-boards-premium/id463344117?mt=8
.See this updated post for info about how SLPs can get free access to several AAC apps, funding tips & links to AAC user Facebook groups: https://omazingkidsllc.com/2016/06/11/aac-tips-how-slps-can-get-free-access-to-aac-apps-aac-app-user-groups-funding-options-more/.
.2017 was a years of ups & downs in the world of AAC apps. It was exciting to see so many great improvements in apps and a couple of new apps released but at the same time very sad to see a few AAC apps either disappear or no longer function properly after the release of iOS 11. I’ve received numerous messages on my OMazing Kids page from parents and therapists with very heartbreaking stories of AAC users losing their voice when iOS 11 came out. Several small AAC app developers had not updated those apps in almost 5 years. It’s one thing to lose a favorite game or therapy app but a whole different thing to lose an AAC app. It’s a cautionary tale to anyone who has thoughts of developing a new AAC app. Beyond the initial costs of developing the app, it is imperative that you also have a very well thought out long term plan and finances for supporting and keeping an AAC app updated.
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A hungry mouse discovers the alphabet, nibble by nibble, in this playful tale. When the letter M comes upon a hungry little mouse with a delicious-looking cherry, he can’t help but ask for a bite. The mouse reluctantly agrees, only for the M to devour the entire thing! In exchange, the M offers the mouse some of itself, but after a few bites the M has suddenly become an N. So begins the mouse’s journey through the many letters of the alphabet thanks to some creative nibbling and imaginative illustrations from debut author/illustrator Zebo Ludvicek.

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What I love about this book: It is fun to read aloud, has bold illustrations and has several opportunities for modeling core vocabulary for AAC.

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Core vocabulary for AAC:

• have

• not

• more

• all

• me

• like

• look

• can

• up

• see

• here

• go

• no

• you

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Here is a free printable 4 page PDF of the symbols for that Core Vocabulary in the LAMP Words For Life, Speak For Yourself, Proloquo2Go & Snap + Core First apps to help during aided language input (modeling) during shared reading activities:

Facebook Messaging for OMazing Kids: http://m.me/OMazingKidsYoga (note: Facebook frequently changes the link to messaging so if this one doesn’t work head over to my page and click on the “Send Message” button)

Angela Moorad is the founder of OMazing Kids, LLC and is an ASHA certified & licensed pediatric Speech-Language Pathologist and Kids Yoga Teacher with 28 years experience working in a variety of settings (early intervention, schools, teletherapy & a nonprofit pediatric rehab hospital for children with developmental disabilities). She is an app beta tester for educational & therapeutic app developers and loves sharing info about great apps, products, books & toys to use with kids of all abilities.

Looking for high quality apps specifically designed for early readers? To go with classroom themes? Or to target core vocabulary for kids using AAC? Then check out the well designed series of apps by Libby Curran, an award winning teacher, at The Reading Train. Of course these apps will need to be on a separate device than the one being used for AAC.

• over 200 books organized into 10 categories (story park, colors, shapes, numbers, animals, animal groups, creature features (body parts), life science, physical science & earth and space). The inclusion of science STEAM topics in early readers will be particularly helpful for those of us looking for age respectful resources to use with older patients/students who are still at an early reader level.
• Levels A, B & C. It’s great to have these levels within early readers so you can start off very easy and work up in small steps.
• listen, read and record modes
• tap and hold to have a word highlighted and read to you
• built in picture word dictionary with over 450 words. This area can be sorted alphabetically or by categories/subcategories. I’ve used this dictionary area to help teach kids vocabulary and simple definitions.
• 20 songs
• set up unlimited number of users
• fun train game at the end of each book
• high quality voiceovers and music
• nice graphics and large font against a plain white background
• can easily toggle off the intro song on the home screen
• intuitive app interface
• secured parent/teacher area

It is similar to their first app but has over 140 books. Most are also found in the first app but there are 4 categories unique to this app: ABC, animal homes, story town & story land.

Their third app has 72 books with a sole focus on the alphabet themed books. Alphabet Park is the same as the ABC section in the Reading Train – My First Books app. But this app also offers level 2 (Alphabet Town) and level 3 (Alphabet Land) sections that are unique to this app. It also contains a picture word dictionary and the section of 20 songs. Reading Train: Alphabet Books, Songs & Games by The Learning Station, LLC, https://itunes.apple.com/us/app/reading-train-alphabet-books-songs-games/id903741015?mt=8, $3.99

Wishes for future updates for all of the apps in this series:
• add the ability to adjust the length of time a user has to tap and hold to have a word highlighted and read aloud.
• add the option for auto page turning when a book is in “listen” mode

The FAQ section on their website indicates that they have plans for this. These features would make the app more special needs friendly.

Kreed's World
This is the story of how we were able to become part of Kreed’s World through his communication device. Kreed learns to communicate more and more each week and this is our attempt at documenting how Kreed found his voice and is finally being heard.

Linda J. Burkhart
She’s been doing Assistive Technology & AAC before the internet, cell phones or iPads were invented. She’s a guru of low-tech solutions, PODD & the original MacGyver in the special needs world!

On the Train With Sophie
I started this blog to chronicle our journey with Sophie who was diagnosed with autism in 2012. A “routine” MRI revealed Bilateral Perisylvian Polymicrogyria, a rare brain malformation. Our journey just took a detour. Sophie is still Thomas’ number

Our Ordinary Day
An ordinary mom sharing glimpses of her life, including transracial adoption, special-needs kids, and the typical stuff of life

Star in Her Eye
Star in Her Eye is a blog by author, Heather Kirn Lanier, about mothering a little girl with a rare genetic condition called Wolf-Hirschhorn Syndrome. Great posts about presuming competence & AAC (uses SFY)

Technology for Special Education Needs
I love integrating technology with classroom instruction. It offers differentiation and accessibility to all students. I also enjoy the creativity it offers the classroom teacher.

Vlinder Communication Therapies
Vlinder is Dutch for ‘butterfly’. One family I worked with long ago thanked me with butterfly-themed items along with an analogy. This family felt that their loved one had been “trapped” in a cocoon by his inability to effectively communicate.

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